Introduction Patient education is essential for older adults with cancer and their caregivers to support understanding of diagnosis and treatment. However, the evidence describing patient education interventions has not been comprehensively mapped. Our objective was to characterize the features, delivery approaches, and outcomes of patient education interventions developed for older adults with cancer and/or their caregivers across any study design, and to identify gaps in the evidence. Materials and methods A scoping review was conducted using the Arksey and O’Malley framework and reported according to the PRISMA-ScR guideline. MEDLINE, EMBASE, EMCARE, CENTRAL, PsycINFO, and Scopus were searched on January 23, 2025. Studies published from 2000 onward were included if they evaluated healthcare professional-delivered patient education. Results From 26,898 records screened, 93 studies met inclusion criteria. Most interventions were delivered pre-treatment (n = 63), with surgery the most common context (n = 31). Common aims included side-effect prevention (n = 32) and supporting treatment decision-making (n = 26). Caregiver involvement was limited. Outcomes were clustered into 20 domains. Frequent reported domains were satisfaction/acceptability (52 occurrences) and knowledge/understanding (46 occurrences), while caregiver outcomes and clinical endpoints were rarely assessed. Discussion Patient education interventions generally improved knowledge and satisfaction, but evidence for clinical or system-level impacts remains limited. Key gaps include minimal integration of geriatric assessment, limited adaptation for cognitive impairment, sparse caregiver-specific outcomes, and inconsistent reporting of unintended effects. Future research should better integrate caregiver needs and geriatric principles into patient education design.
Purpose To report long-term tumor control, toxicity, and functional outcomes after a second course of fractionated radiation therapy for recurrent craniopharyngioma previously treated with radiation therapy. Methods and Materials We identified all patients with craniopharyngioma with recurrent or progressive disease, unsuitable for further medical management or re-resection, who underwent 2 courses of fractionated photon radiation therapy at a single institution between 1998 and 2024. Reirradiation was delivered to 54 Gy in 30 fractions with full overlap of the initial target; dose constraints to optic nerves, chiasm, and brainstem were Dmax/D0.03cc (Maximum Dose or Dose to 0.03 cubic centimetres) ≤54 Gy. Outcomes were summarized descriptively. Results Six patients received reirradiation a mean of 9.8 years (range, 5.6-20.5) after initial radiation therapy (50-54 Gy in 25-30 fractions). Median follow-up after reirradiation was 4.1 years (range, 0.4-8.8). At the last follow-up, 4 patients were alive, all with local disease control (2 with radiological regression, 2 with stable disease). Two deaths occurred (1 due to progressive disease and 1 due to functional decline with stable imaging). Visual outcomes were heterogeneous: 1 patient maintained intact vision; others had intermittent diplopia, bitemporal hemianopsia, or unilateral blindness with contralateral impairment. Endocrinopathy was frequent: 3 of 4 survivors had pan-hypopituitarism; 1 had partial deficits (hypothyroidism/amenorrhea). Functional status was impaired in survivors, with the inability to work or study due to fatigue, visual loss, or cognitive issues. Additional toxicities included posttreatment seizures requiring hospitalization (n = 1) and transient dexamethasone for headache (n = 1). Conclusions In carefully selected patients lacking other curative options, modern highly conformal reirradiation can achieve meaningful local control after prior high-dose radiation therapy, but carries an additive risk of visual, endocrine, and functional morbidity. Decisions should be individualized within a multidisciplinary team to identify appropriate cases for reirradiation and to ensure thorough long-term follow-up to manage delayed toxicity.
Introduction Predicting treatment-related toxicity in older adults remains challenging. The Cancer and Aging Research Group (CARG) toxicity tool is one of the most established toxicity prediction tools; however, validation studies have shown variable predictive ability. Our primary objective was to validate the CARG toxicity tool in a cohort of Canadian older adults on systemic therapy. Secondary objectives were to compare the tool's performance with Eastern Cooperative Oncology Group Performance Status (ECOG-PS), Geriatric-8 (G8), and Vulnerable Elders Survey (VES-13) scales and examine whether these tools could predict treatment discontinuation, emergency room (ER) visits, and hospitalizations. Materials and methods This retrospective analysis included patients aged ≥65 who completed a Comprehensive Geriatric Assessment (CGA) and received systemic therapy at an academic Canadian cancer centre. The area under the receiver operating characteristic curve (AUC) was calculated for the CARG and compared to ECOG-PS, G8, and VES-13. Logistic regression was performed to examine the association of the CARG toxicity tool with Grade ≥ 3 toxicity, ER visits, and hospitalizations. Results One hundred sixty-eight patients were included, 87 (51.8%) female, mean age 79.1 (SD 5.9). At least one Grade ≥ 3 toxicity was observed in 118 patients (70.2%). In toxicity prediction, the CARG toxicity tool had modest performance (AUC 0.64, 95% CI 0.55–0.73) but outperformed the ECOG-PS (AUC 0.57), VES-13 (AUC 0.55), and G8 (AUC 0.54), though this was not statistically significant (p = 0.17). On multivariable logistic regression, the high-risk category on the CARG toxicity tool was significantly associated with Grade ≥ 3 toxicity (OR 2.93 (95% CI 1.10–7.79, p = 0.03). High-risk CARG toxicity scores were correlated with treatment incompletion (OR 2.12, CI 1.04–4.30, p = 0.04) but not with hospitalization or ER visits. ECOG-PS ≥ 2 (OR 1.99, 95% CI 1.04–3.80, p = 0.04) and abnormal G8 scores (OR 2.71, 95% CI 1.13–6.51, p = 0.03) showed stronger association with these outcomes, respectively. The CARG tool performed similarly when restricted to chemotherapy regimens alone and for solid vs hematological malignancies. Discussion The CARG toxicity tool demonstrated modest performance in toxicity prediction in a Canadian older adult cohort but appears superior to other tools. It was also associated with treatment incompletion although the ECOG-PS and G8 showed stronger association with hospitalization and ER visits.
Parkinson’s disease (PD) is characterized by the loss of dopaminergic neurons in the substantia nigra (SN), accumulation of alpha-synuclein (a-Syn)-rich aggregates, and the development of both motor and non-motor symptoms. The absence of a cure for PD underscores the critical need for animal models that recapitulate both its molecular hallmarks and the spectrum of behavioral symptoms to elucidate pathogenic mechanisms and advance therapeutic development. While the virus-mediated a-Syn overexpression rat model recapitulates progressive dopaminergic neurodegeneration and motor deficits, its non-motor phenotypic profile remains poorly characterized. In this study, we investigated the behavioral consequences of targeted adeno-associated virus (AAV)-mediated overexpression of aggregate-prone mutant A53T a-Syn within the rat SN bilaterally. We confirmed dopaminergic neurodegeneration within 6 weeks, along with progressive motor impairments evident as reduced locomotion in the open field test and increased foot slips in the grid walking test as early as 3 weeks post-AAV injection. The dopaminergic origin of the motor deficit in the grid walking was confirmed at the 6-week timepoint by its attenuation with L-DOPA treatment. Crucially, animals overexpressing A53T a-Syn exhibited reduced responsiveness to palatable stimulation in the sucrose preference test in the context of advanced neurodegeneration. No changes in anxiety-like behaviors, olfactory function, or recognition memory were observed when compared with age-matched controls. These findings suggest that, in addition to motor impairments, bilateral A53T a-Syn overexpression induces depression-like behavior, providing a valuable tool for studying the pathogenesis and treatment of non-motor affective symptoms in PD.
Robot-assisted distal pancreatectomy (RDP) was developed to overcome technical limitations of laparoscopic distal pancreatectomy (LDP), yet uncertainty persists regarding oncologic adequacy, learning-curve effects, and outcomes in high-risk subgroups. We synthesized current evidence to address these gaps. We systematically searched PubMed and EMBASE, in accordance with PRISMA guidelines, from inception to 2025 to identify comparative studies of RDP versus LDP. Using random-effects models, we calculated weighted mean differences (WMDs) for continuous outcomes and risk ratios (RRs) for dichotomous outcomes, and performed subgroup analyses, including pancreatic ductal adenocarcinoma (PDAC), along with meta-regression to explore heterogeneity sources. Sixty-four studies comprising 15,790 patients (5,723 RDP; 10,067 LDP; mean age 60.5 years; BMI 26.1 kg/m²) were included. RDP resulted in lower blood loss (WMD − 52.0 mL; p < 0.00001), fewer conversions (RR 0.49; p < 0.00001), and fewer unplanned splenectomies (RR 0.59; p < 0.0001). Operative time was longer (WMD + 24.06 min; p < 0.00001). Postoperative morbidity, POPF, PPH, infection, reintervention, and mortality were comparable. Length of stay was shorter with RDP (WMD − 0.57 days; p < 0.00001). Although lymph node yield appeared higher with LDP in the overall and PDAC cohorts, this difference was no longer significant in a sensitivity analysis, and R0 resection rates remained comparable. Costs were higher with RDP, with substantial heterogeneity. RDP and LDP demonstrate comparable safety and oncologic outcomes. RDP reduces blood loss, conversions, and splenectomy but increases operative time and cost. The operative time disadvantage likely reflects learning-curve. Selective use in high-risk and complex resections is supported; cost-effectiveness warrants further study.
